The objective of this study was to evaluate the association between cardiorespiratory fitness and sudden cardiac death in a population-based sample of men. The study population included 2,368 men aged 42 to 60 years. During the 17-year of follow-up, a total of 146 cases of sudden cardiac deaths were recorded. Analyses revealed that an increase of 1 metabolic equivalent (MET) in maximal oxygen consumption predicted a 22% reduction in the risk of sudden cardiac death. However, cardiorespiratory fitness led to only a modest increase in discrimination, with the C-index increasing from 0.760 to 0.767 and the net reclassification index showed no significant change. Thus, these results suggest that good cardiorespiratory fitness is associated with lower risk of sudden cardiac death, but it does not add predictive value beyond traditional risk factors. In his editorial comment, Lauer MS underlined the good quality of this study because it included collection of multiple important baseline characteristics, sophisticated cardiorespiratory fitness measurements and long-term follow-up. He highlighted the fact that the authors went further in their analyses by determining the ability of cardiorespiratory fitness to improve the discrimination and reclassification. He also suggested that serial measurements of maximal oxygen consumption may have improved prediction.
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